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P4HB Purpose Developed Strategic Work Plan with three objectives: –Increase access to and utilization of Preventive Health Services for all females from birth through child-bearing age. –Increase number of intended and appropriately timed births to plan members (Medicaid FFS, Medicaid Managed Care, SHBP, Commercial Insurers) –Facilitate early access to prenatal care providers

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P4HB Purpose Family Planning Waiver – primary strategy to achieve Objective 2 Goals –Reduce Georgia’s LBW and VLBW rates –Reduce number of unintended pregnancies in Georgia –Reduce Georgia’s Medicaid costs Participation in the waiver is voluntary for all participants - women who have not been pregnant and women who would otherwise lose Medicaid eligibility 60 days post partum.

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Waiver Approval Process Submitted formal application in February 2010 Responded to CMS concerns re financial support for waiver – funding to be included in SFY 11 budget Established positive working relationship with project officer (PO). Very responsive to her informal requests for information –Understood PO was Georgia’s messenger to the Federal Review Team Official RAI sent late March Responded early April 2010

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Waiver Approval Process Additional data provided as quickly as possible to PO when requested Georgia: PO dialogue included clear messaging re waiver population and components. Gave justification why SPA option not viable for Georgia. PO communicated federal teams concerns re IPC and collaborated with Georgia to resolve those concerns PO worked with Georgia to develop new methodology for budget neutrality that incorporated reductions in VLBW births.

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Approvals State legislature approved waiver funding for FY 11 inclusive of IPC in April –$15,000,000 budget for first six (6) months of waiver operation –90% Federal Funds –10% State Funds Legislature identified total FP savings for FY 11 –$10,000,000 for the first six (6) months of FY 11 CMS approved waiver October 29, 2010 – 8 mos after formal application

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Eligibility Criteria Family Planning Only – new Medicaid eligibility category –Women: 18 – 44 –Uninsured –< 200 FPL Interpregnancy Care (IPC) – new Medicaid eligibility category –All of the above, plus –Women who delivered a VLBW infant on or after the first day of implementation of the waiver Waiver eligibility is for 24 months for IPC with re- determination after 12 months of participation

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Evaluation Plan Evaluation plan must utilize quasi-experimental design Draft plan to CMS by end of February 2011 Contracted with Emory University to evaluate waiver Incorporated evaluation plan components into CMO contracts and placed them at risk for meeting performance targets

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Additional Information Interaction with Title X –Title X clinics can provide services under the waiver Waiver vs Title X –Continuity of care Approx. 50,000 women lost Medicaid coverage following their deliveries in days of care post partum only allows limited family planning services CMS aware of efficacy of Medicaid FP services Medicaid cost savings are significant at both the Federal and State levels Accessing Public Health Clinics –Women choosing FP services via Medicaid will have access to all CMO network FP waiver providers